Our crazy mental health system

A crusading journalist with a bipolar son says jails have become warehouses for the mad -- and argues for forced commitment.

By Marissa Kantor

Read more: Prisons, Health Care, Psychiatry, Life

April 11, 2006 | Pete Earley never thought he'd be writing this book. No parent would. Spurred on by his son Mike's journey through diagnosis and treatment for bipolar disorder, Earley, a former Washington Post reporter and the author of several acclaimed nonfiction books, begins "Crazy: A Father's Search Through America's Mental Health Madness" in the midst of personal crisis. But though "Crazy" starts as a chronicle of his family's journey, Earley's instincts as an investigative reporter soon take over. While his son shuttles through the hands of doctors and lawyers, Earley undertakes a larger examination of America's labyrinthine mental health system, culminating in an investigation of daily life within the psychiatric ward of the Miami-Dade County Jail. By weaving together both narratives, Earley creates a work of advocacy journalism that is not only a record of one man's struggle with his child's uncertain prognosis but also a look at the ways in which mental illness -- given the legal barriers to care and the inadequacy of the current system -- can devastate any American family.

Earley's work is grounded in two simple premises. The first is that mental illness can happen to anyone at any time and it is never the affected person's fault. The second is that jails and prisons have become our new state asylums, where we hide rather than rehabilitate people. During his year in Miami, Earley is granted complete access to the primary psychiatric unit, sometimes called "the forgotten floor," on the ninth floor of the jail. There he finds "hidden prisoners" with severe mental illness -- who have committed crimes ranging from felonies to petty misdemeanors -- on suicide watch, while psychiatrists try to force mumbling, confused patients to take medication so they will be stable enough to stand trial.

But Earley's solution to America's mental health crisis is nothing if not controversial: He advocates for a reinstitution of the old state hospital system, for places outside the jail system that can house people with severe mental illnesses who have nowhere else to go. After sitting in an emergency room cradling his psychotic son for hours, only to see him denied care because the state of Virginia's strict interpretation of the imminent danger clause determined he was not an immediate threat to himself and others, Earley is moved to reach out to other parents to let them know that they are not alone. That same experience also convinces Earley that a reconsideration of forced commitment -- a move that would certainly require a serious national debate about civil rights and when to suspend them -- is a reform that mental health advocates should not dismiss out of hand. In the end, "Crazy" is as much a call to arms as it is a portrait of a hidden population.

Salon spoke with Earley by phone about his experiences as a parent of a child with bipolar disorder, the need for more police training about mental illness, and how America might begin to repair its broken mental health system.

The words "crazy" and "madness" are two very loaded terms in the mental health community. Why did you decide to use them in the title of your book?

Well, just your asking that shows that you know more about the mental health system than I did when [my publisher and I] made that choice. Actually, originally we were going to call the book "The Ninth Floor," but my editor felt that was too obtuse. So we came up with "Crazy" -- and the whole point was this idea that the system is crazy, it's broken, it's a mess. Since then, though, I've thought, Gee, it wasn't probably the best choice-- because some people find it offensive and don't look beyond that word, don't see that we're talking about the system.

Partly I'm a newcomer to this, and I didn't realize that some people find the term "the mentally ill" insulting, that it should be people with mental illnesses. But basically, I feel like I've spent three years of my life on this and my motives are pure. I have a son who is [in the mental health system] and this is an issue I care passionately about.

You make a point of repeating that mental illness can happen to anyone. Do you think people's fear of disease is responsible for some of the stigmatizing of people with severe mental illness that goes on in America?

Mental illnesses are so frightening and there's so much ignorance about them that I think it comforts people to think, Oh, well, it happens to these people because they deserve it. I've heard a lot of people, including prosecutors, say, Oh, that person's mentally ill but they got [that way] by taking drugs -- even though the National Institute of Mental Health says that's impossible. Those are the same rationalizations that have been used throughout history, from the time we first started recognizing that some people act differently. We want to blame the individual because we don't want to think it can happen to us. We want to think that the person who's ranting and raving on a street corner and living on the street somehow wants to be that way. That way we can justify walking by them and not caring and reaching out. A lot of what we do helps us cover up our own guilt, but I also think it covers up the fear.

It does seem like severe mental illnesses are largely ignored until a sensational crime takes place -- like someone with schizophrenia pushing someone in front of a subway train. Why do you think those are the only times people take notice?

When people who have mental illnesses start being a threat, by pushing someone in front of a subway, or chopping off someone's arms, or drowning their children in a bathtub, then all of a sudden that frightens people and people want to do something about it. The people who are really pushing to stop people with mental illnesses from being put in jails and prisons are sheriffs, police and correctional officers because they know they don't belong there.

But what I explain in my book is that you can describe the conditions that the mentally ill face, you can talk about how jails and prisons have become our new asylums, you can talk about how there are no services there. But talking doesn't get people to act. So it's kind of a double-edged sword -- we don't want to stigmatize the mentally ill as being dangerous, because the majority of them are not, but by the same token, that seems to be the only way that people will sit up and take notice that conditions are lousy and that we need to reexamine the whole system.

Next page: We havent really helped or changed these people's lives. We've simply hidden them better